Thursday, April 8, 2010

Why I love and (simultaneously) hate ER medicine.

This was my Tuesday night:

First, a cat was presented to me after being hit by a car. The car apparently missed his body and just hit his head. Either that or his head was run over. Blood poured from his nose, mouth, and eyes. His head was the size of a pumpkin. Other than obvious multiple jaw fractures and head trauma, he didn't look too bad. After talking to the owners at length about the amazing regenerative abilities of cats, they decided to treat him and cross their fingers. He actually did pretty well through the night, although he is facing lots of surgery, a feeding tube, and slow convalescence at our local specialty clinic.

Two dogs both shot with a .22 (my guess based on entry/exit wound size). The first was a smaller breed dog (around 35 pounds). The bullet had entered the back of the thigh and come out the front. While excruciatingly painful, he was not in immediate life-threatening danger. He was shocky and painful...but this was quickly rectified with IV fluids and aggressive pain medications.

His housemate was not so lucky. A much bigger dog (75 pounds), she had sustained a bullet through the thorax and out the abdomen. For the severity of the wound, she was more stable than I would expect. We worked on her for hours (fluids - crystalloids and colloids, pain medications, other stabilization efforts) before xraying her. I was not happy with what I saw - free gas in the abdomen, as well as mucho fluid and a very unhappy looking (aka ruptured) GI tract. Sadly, she died while being induced for surgery. Post-mortem exam revealed 2 holes in her stomach, 2 ruptured areas of small intestines, a badly lacerated liver, a hole in the diaphragm, and an abdomen full of feces and gastric contents (including whole kibble). Her death was likely a good thing. Some things are just too broke to fix. Her owner is a lovely man - a military medic and veteran who thanked me profusely for my work and actually came in person the next morning to thank me.

A small dog with a lacerated pad and very nice owners.

Two dogs with mild diarrhea.

A puppy that had been run-over by a car and picked up by a very Good Samaritan who wanted to pay for his care. Unfortunately, the puppy had a severe body wall abdominal hernia. I could feel intestines and bladder in the hernia. He needed surgery, and the $600 the poor "owner" had borrowed wouldn't even begin to cover the care this puppy would have needed. He was TTJ'd after much discussion with the distraught Good Sam.

A dog with a torn and bloody toenail and a ***bleep*** owner who couldn't understand why he would have to wait to have his dog's toenail addressed - despite being told repeatedly about the dying gunshot wound in the back.

A cat with bloody nasal discharge, a respiratory rate of 72, a heart murmur, and a body temperature of 94. I suspected congestive heart failure secondary to occult (until that point anyway) hypertrophic cardiomyopathy (HCM), but the owner did not have the finances to proceed with treatment. Even if she had, the cat's prognosis was guarded at best.

It was a loooooong, depressing, tiring night. My colleague has been very ill (doctors are suspicious of mono). I was supposed to be off Monday and Tuesday (the end of my 9 day off stint), but she was so sick, I worked for her. She's offered to work my next 2 shifts (Wed/Thurs), and as long as she feels up to it, I'm taking her up on it. I need a break after the last 2 nights!


Andrew said...

Did I ever mention I am proud to be your brother? I am amazed at what you have learned to deal with in your daily duties. Poor shot doggy. What is wrong with people?

Kristen said...

What is "TTJ'd"? I'm guessing from the context that it was curtains. That sounds like a rough night.

The Homeless Parrot said...

TTJ = transfer to jesus.